Journey into the 2020 Trachoma-Free Eritrea

Dr. Alem Zekarias

By Semir Seid

Trachoma is an eye disease and one of the many causes for people’s loss of vision and blindness. It is one of the eighteen underestimated tropical diseases that infected around a billion people with lower standard of living. According to the 2016 WHO Alliance for GET 2020 Database, 200 million people live in areas where trachoma is highly likely to spread. At the moment, 2.2 million of the world population has developed a vision problem due to trachoma. Out of this figure, it is sad to see the 1.2 million have already become blind. Trachoma is an easily communicable and gradually developing disease; but, it can be prevented if people follow the commonly prescribed health precautions.

The prevalence rate of this disease has been under research and it is concluded that its prevention procedures are much worth endeavors than to cure it. It can of course be cured medically if detected soon. A recent trachoma fact sheet indicates that the disease covers 3% of the overall blindness in the world. Mothers and children are the most vulnerable victims of this disease. Recent research of the World Health Organization (WHO) shows that 12.4 million children are infected by active trachoma. In terms of gender, women get four time more eye surgeries from this disease than men.

The fact that trachoma is a gradually developing, bacteria caused disease, can be dangerous to the eye through an extended period of time. Trachoma can be seen in five levels until the victim reaches the severe stage. At the first stage the disease shows some acne in the eye lid. The next stage leaves the eye lead to an infection. The third stage is scarring of the eye lid; a scar in the eye lid that leads to the fourth stage-trichiasis where the ingrown eye lash keeps pricking the center of the eye. The last stage is the corneal opacity which is a severe stage that can grow into blindness. Surgery is imminent before the corneal opacity takes place.

Oculists note that the prevention of trachoma is easier than its medication procedures, since the eye is too sensitive enough to be restored to its former vision. Trachoma is easily transmitted from an infected person to another in the absence of personal and environmental hygiene, through flies, by sharing same towels, from an infected mother to a child, sharing the same bed. The disease can be stopped using the Surgery Antibiotic, Facial cleanliness and Environmental hygiene (SAFE) program of the WHO. This new program is provided to prevent the spread of trachoma and, thus, eliminate it for all time. Surgeries prevent the occurrence of blindness to a patient. The surgery conducted for trachoma is soft and quick that it can be executed within 15 minutes. Except in Northern Red Sea region, all the regions have trained health agents of their villages to tackle such incidents through surgeries. The NRS region has scheduled training of trachoma surgeries for health agents of villages next year to conduct outreach surgeries just like other regions.

Trachoma is also treated by two other methods: Azithromycin (capsule and syrup form) taken once per year as well as Tetracycline eye ointment of 1% where patient is required to take it twice a day for six months. The second medication is meant for those who are unable to take Azithromycin including infants, pregnant women and other patients. The health agents distribute the trachoma drugs but before distribution all stakeholders hold meetings and campaigns regarding the distribution and particularly to deliver the important messages of face washing and environmental hygiene.

Dr. Alem Zekarias head of the National Blindness Prevention and Control program launched in 2004, said that the objective of the program is to conduct research related to eye diseases and find solutions to prevent them and come up with cure. The main task of the program is to identify and prevent any eye disease in the country. The program has been following the 2008 declarations of the WHO in which any nation with a trachoma prevalence rate of 10% is not in safe zone. Meanwhile, of all the causes of blindness in Eritrea, trachoma contributes only 1%. Nonetheless, a previous national research showed that in 8 out of the 35 sub regions with in only three regions- Southern, Gash Barka and Northern Red Sea trachoma has been registered as a major health problem. The eight sub regions had exceeded the WHO rate and a trachoma campaign was imminently needed. The sub regions in the Southern region have prevalence rates ranging from 10% in Emni Haili, Mendefera, Dubarwa and Areza to 26% in Adi kuala, and 67% in Mai Mne.

Since 2011, annual campaigns of mass drug distribution has reduced the national prevalence rate from the WHO rate of 10%. In 2014, after a medication has been supplied, impact assessment was made and the result was positive. Three rounds of drug distribution were made in all the infected sub regions. According to the six year impact assessment, the sub regions of Adi kuala, Nakfa and Senafe have made a remarkable reduction in children’s trachoma prevalence rate. In the 2014 research conducted in Anseba region, eight sub regions were found to have trachoma prevalence rate between 5 and 10%, and a regular impact assessment is executed to keep the figure at its minimum rate.

Similar endeavors are ongoing across the country to reduce the prevalence rate to less than five percent. In 2018, the plan of the National Blindness Prevention and Control program is to make a national impact assessment and in 2019 a surveillance program is scheduled to declare a trachoma free Eritrea by 2020.

In a decade long program (2010- 2020), the goal was made clear to reach a Trachoma-Free nation. At present, people of the sub regions mentioned above have been made fully aware of the causes and preventing methods of trachoma. The results are the living examples that show a behavioral change in people who are frequently seen to visit health centers whenever any eye infection is sensed. Despite the growing awareness, traditional medications to treat trachoma have not been totally eradicated and the Dr. Alem recommends that people should feel free to visit health centers whenever necessary.

Further, to eradicate the signs of this disease more endeavors are currently underway. The 2015 WHO elimination campaign targets a less than 5% prevalence rate and, thus, the National Blindness Prevention and Control program is working on this percentile to declare a Trachoma-Free Eritrea by the beginning of 2020. The campaign of the organization decided to distribute drugs once for those less than 10% and greater than 5% trachoma vulnerable areas. If done correctly, it concluded that nations can be free of trachoma for good.

Generally, it is believed that trachoma is common in 42 countries in the world. Most of these nations are located below the African Sahara desert and the southern and eastern Asia.

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